Child First Meets HHS Criteria

Model effectiveness research report last updated: 2011

Model overview

Theoretical approach

Child First intervenes with vulnerable young children and families at the earliest possible time to prevent and heal the effects of trauma and adversity. The goal is to decrease the incidence of emotional and behavioral disturbance, developmental and learning problems, and abuse and neglect among high-risk young children and their families. The Child First model is based on brain development research, which shows that extremely high-stress environments (including poverty, maternal depression, domestic violence, abuse and neglect, substance abuse, and homelessness) are toxic to the developing brain of the young child. Child First aims to build a nurturing, consistent, and responsive parent-child relationship, which buffers and protects the child’s brain from these stressors. In addition, the model is designed to stabilize and decrease the multiple concrete challenges in the family’s life.

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Model services

Child First affiliate sites assign each family a team consisting of a licensed master’s-level mental health/developmental clinician responsible for assessment and therapeutic intervention and a care coordinator responsible for connecting families to community services and supports. The Child First model involves the following:

  • Engagement and assessment of child and family needs. The clinician and care coordinator work as a team to engage and build a trusting relationship with the family. To understand the family’s strengths and challenges, the team, in collaboration with the family, uses an ecological approach to assess the child’s health and development, important relationships, and the family’s culture and priorities. The assessment includes a protocol of standardized and informal measures; discussions with parents; observations in the home and early care and education settings (see details below); information from the child’s health provider, teacher, and others who regularly interact with the child and family; and reviews of records.  
  • Observation and consultation in early care and education setting. The mental health/developmental clinician gathers information within any early care setting attended by the child receiving home visiting services. These settings may include family, friend, and neighbor care; early care and education programs; and schools. The clinician gathers information through observations; conversations with the teacher and school administration; and review of any records. The clinician works with the teacher to understand the meaning of the child’s behavior, develop classroom strategies to decrease challenging behaviors and enhance the child’s social-emotional development, and coordinate efforts between the child’s early care and education setting and the home.  
  • Development of a child and family plan of care. The plan of care outlines the therapeutic intervention; parenting supports; and community-based services for the child, parents, and other family members. The Child First team develops the plan with the family during home visits; it reflects the parents’ goals, priorities, strengths, culture, and needs. The initial plan is revised as the family accomplishes goals and subsequently focuses on new challenges. The plan is reviewed at least every three months.  
  • Parent-child mental health intervention. The home-based intervention incorporates both Child-Parent Psychotherapy (CPP) and parenting support and guidance. It is a two-generation approach, designed to strengthen the parent-child relationship and promote secure attachment so the relationship both serves as a protective buffer from unavoidable stress and directly facilitates emotional, language, and cognitive growth. It addresses the experience of trauma and adversity in the child’s life, with the goal of helping the child heal and resolving behavioral problems. The model aims to promote parents’ understanding of normal and atypical developmental challenges and expectations; safety and joy in the relationship; parental reflection on the meaning and feelings motivating a child’s behavior; problem solving and the development of new strategies; and reflection on the psychodynamic relationship between parental history, feelings, and the parental response to the child.  
  • Promotion of executive functioning. The clinician works with the parent on emotional regulation. The care coordinator scaffolds and supports the parent in the development of other executive functioning capacities, such as goal planning. The care coordinator works with the parent to develop individual and family goals, prioritize those goals, create plans to accomplish them, monitor progress, and revise those plans. In addition, the care coordinator provides the parent with relationship-based activities and routines, based on the Abecedarian Approach, that help the parent scaffold executive functioning skills with the child.  
  • Care coordination. The care coordinator’s priority is to help stabilize the family, especially in the face of acute challenges, such as threats to the child’s safety, possible eviction, or lack of adequate food. To help decrease stress and enhance the child’s and family’s development, the care coordinator helps connect the family to comprehensive community-based services and supports, and directly addresses barriers to service access.

The Child First curriculum includes topics, concepts, and implementation methods delivered based on the unique needs of the child and family. Child First is a flexible, relationship-based, psychotherapeutic intervention. The curriculum does not designate what content should be covered for specified visits. However, it does specify what constitutes fidelity to the Child First model.

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Intended population

Child First serves pregnant women and families with children from birth through age 5 years in which (1) children have emotional, behavioral, or developmental difficulties; or (2) the family faces multiple environmental and psychosocial challenges (which Child First views as social determinants of health) that may lead to negative parent and child outcomes, such as maternal depression, domestic violence, substance abuse, homelessness, or abuse and neglect. Families are served without regard for their legal status or the number of children in the family.

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Where to find out more

Child First, Inc.
35 Nutmeg Drive, Suite 385
Trumbull, CT 06611
Website: www.childfirst.org/

Darcy Lowell, M.D., CEO and Founder
Phone: (203) 538-5225
Email: dlowell@childfirst.org

Mary Peniston, Chief Program Officer
Phone: (203) 538-5224
Email: mpeniston@childfirst.org

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Effects shown in research

Maternal health

Findings rated high

Child First
Show findings details
Outcome measure Effect Follow-up timing Sample Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
BSI
FavorableUnfavorable or ambiguousNo Effect
12 months Bridgeport, CT 117 families Mean = 21.00 Mean = 35.10 Mean difference = -14.10 HomVEE calculated = 0.56 p < 0.01
BSI
FavorableUnfavorable or ambiguousNo Effect
6 months Bridgeport, CT 117 families Mean = 32.70 Mean = 33.00 Mean difference = -0.30 HomVEE calculated = 0.00 p > 0.05
BSI (proportion with clinically concerning problems)
FavorableUnfavorable or ambiguousNo Effect
12 months Bridgeport, CT 117 families % (adjusted) = 14.00 Adjusted mean % = 39.00 Difference = -25.00 HomVEE calculated = -0.83 p < 0.05
BSI (proportion with clinically concerning problems)
FavorableUnfavorable or ambiguousNo Effect
6 months Bridgeport, CT 117 families % (adjusted) = 25.80 Adjusted mean % = 31.80 Difference = -6.00 HomVEE calculated = -0.18 p > 0.05
CES-D
FavorableUnfavorable or ambiguousNo Effect
12 months Bridgeport, CT 117 families Mean = 13.50 Mean = 17.40 Mean difference = -3.90 HomVEE calculated = 0.45 p < 0.05
CES-D
FavorableUnfavorable or ambiguousNo Effect
6 months Bridgeport, CT 117 families Mean = 16.90 Mean = 18.50 Mean difference = -1.60 HomVEE calculated = 0.20 p > 0.05
CES-D (proportion with clinically concerning problems)
FavorableUnfavorable or ambiguousNo Effect
12 months Bridgeport, CT 117 families % (adjusted) = 33.30 Adjusted mean % = 37.90 Difference = -4.60 HomVEE calculated = -0.12 p > 0.05
CES-D (proportion with clinically concerning problems)
FavorableUnfavorable or ambiguousNo Effect
6 months Bridgeport, CT 117 families % (adjusted) = 46.00 Adjusted mean % = 40.80 Difference = 5.20 HomVEE calculated = 0.13 p > 0.05
PSI difficult child
FavorableUnfavorable or ambiguousNo Effect
12 months Bridgeport, CT 117 families Mean = 24.90 Mean = 25.90 Mean difference = -1.00 HomVEE calculated = 0.28 p > 0.05
PSI difficult child
FavorableUnfavorable or ambiguousNo Effect
6 months Bridgeport, CT 117 families Mean = 23.50 Mean = 26.50 Mean difference = -3.00 HomVEE calculated = 0.47 p < 0.05
PSI difficult child (proportion with clinically concerning problems)
FavorableUnfavorable or ambiguousNo Effect
12 months Bridgeport, CT 117 families % (adjusted) = 7.10 Adjusted mean % = 11.90 Difference = -4.80 HomVEE calculated = -0.35 p > 0.05
PSI difficult child (proportion with clinically concerning problems)
FavorableUnfavorable or ambiguousNo Effect
6 months Bridgeport, CT 117 families % (adjusted) = 4.80 Adjusted mean % = 19.70 Difference = -14.90 HomVEE calculated = -0.96 p < 0.05
PSI parent distress
FavorableUnfavorable or ambiguousNo Effect
12 months Bridgeport, CT 117 families Mean = 29.70 Mean = 30.40 Mean difference = -0.70 HomVEE calculated = 0.23 p > 0.05
PSI parent distress
FavorableUnfavorable or ambiguousNo Effect
6 months Bridgeport, CT 117 families Mean = 30.30 Mean = 33.60 Mean difference = -3.30 HomVEE calculated = 0.47 p < 0.05
PSI parent distress (proportion with clinically concerning problems)
FavorableUnfavorable or ambiguousNo Effect
12 months Bridgeport, CT 117 families % (adjusted) = 21.40 Adjusted mean % = 28.80 Difference = -7.40 HomVEE calculated = -0.24 p > 0.05
PSI parent distress (proportion with clinically concerning problems)
FavorableUnfavorable or ambiguousNo Effect
6 months Bridgeport, CT 117 families % (adjusted) = 31.80 Adjusted mean % = 45.50 Difference = -13.70 HomVEE calculated = -0.35 p < 0.05

footnote124

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HomVEE-calculated p-value is greater than 0.05, indicating that this result is not significant.

PSI parent-child dysfunction
FavorableUnfavorable or ambiguousNo Effect
12 months Bridgeport, CT 117 families Mean = 21.60 Mean = 20.60 Mean difference = 1.00 HomVEE calculated = 0.00 p > 0.05
PSI parent-child dysfunction
FavorableUnfavorable or ambiguousNo Effect
6 months Bridgeport, CT 117 families Mean = 20.40 Mean = 21.90 Mean difference = -1.50 HomVEE calculated = 0.27 p > 0.05
PSI parent-child dysfunction (proportion with clinically concerning problems)
FavorableUnfavorable or ambiguousNo Effect
12 months Bridgeport, CT 117 families % (adjusted) = 21.40 Adjusted mean % = 17.40 Difference = 4.40 HomVEE calculated = 0.17 p > 0.05
PSI parent-child dysfunction (proportion with clinically concerning problems)
FavorableUnfavorable or ambiguousNo Effect
6 months Bridgeport, CT 117 families % (adjusted) = 19.10 Adjusted mean % = 22.70 Difference = -3.60 HomVEE calculated = -0.13 p > 0.05
PSI total score
FavorableUnfavorable or ambiguousNo Effect
12 months Bridgeport, CT 117 families Mean = 76.30 Mean = 76.90 Mean difference = -0.60 HomVEE calculated = 0.20 p > 0.05
PSI total score
FavorableUnfavorable or ambiguousNo Effect
6 months Bridgeport, CT 117 families Mean = 74.20 Mean = 81.90 Mean difference = -7.70 HomVEE calculated = 0.49 p < 0.05
PSI total score (proportion with clinically concerning problems)
FavorableUnfavorable or ambiguousNo Effect
12 months Bridgeport, CT 117 families % (adjusted) = 19.60 Adjusted mean % = 22.00 Difference = -2.40 HomVEE calculated = -0.09 p > 0.05
PSI total score (proportion with clinically concerning problems)
FavorableUnfavorable or ambiguousNo Effect
6 months Bridgeport, CT 117 families % (adjusted) = 20.60 Adjusted mean % = 34.90 Difference = -14.30 HomVEE calculated = -0.44 p < 0.05
Any PSI scale (proportion with clinically concerning problems)
FavorableUnfavorable or ambiguousNo Effect
12 months Bridgeport, CT 117 families % (adjusted) = 32.70 Adjusted mean % = 44.10 Difference = -11.40 HomVEE calculated = -0.29 p < 0.05

footnote124

Submitted by user on

HomVEE-calculated p-value is greater than 0.05, indicating that this result is not significant.

Any PSI scale (proportion with clinically concerning problems)
FavorableUnfavorable or ambiguousNo Effect
6 months Bridgeport, CT 117 families % (adjusted) = 38.10 Adjusted mean % = 57.60 Difference = -19.50 HomVEE calculated = -0.48 p < 0.05
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Child development and school readiness

Findings rated high

Child First
Show findings details
Outcome measure Effect Follow-up timing Sample Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
ITSEA dysregulation
FavorableUnfavorable or ambiguousNo Effect
12 months Bridgeport, CT 117 families Mean = 16.40 Mean = 20.70 Mean difference = -4.30 HomVEE calculated = 0.36 p > 0.05
ITSEA dysregulation
FavorableUnfavorable or ambiguousNo Effect
6 months Bridgeport, CT 117 families Mean = 18.40 Mean = 21.40 Mean difference = -3.00 HomVEE calculated = 0.22 p > 0.05
ITSEA dysregulation (proportion with clinically concerning problems)
FavorableUnfavorable or ambiguousNo Effect
12 months Bridgeport, CT 117 families % (adjusted) = 11.30 Adjusted mean % = 12.70 Difference = -1.40 HomVEE calculated = -0.08 p > 0.05
ITSEA dysregulation (proportion with clinically concerning problems)
FavorableUnfavorable or ambiguousNo Effect
6 months Bridgeport, CT 117 families % (adjusted) = 7.00 Adjusted mean % = 15.90 Difference = -8.90 HomVEE calculated = -0.56 p > 0.05
ITSEA externalizing
FavorableUnfavorable or ambiguousNo Effect
12 months Bridgeport, CT 117 families Mean = 13.80 Mean = 18.40 Mean difference = -4.60 HomVEE calculated = 0.49 p < 0.05
ITSEA externalizing
FavorableUnfavorable or ambiguousNo Effect
6 months Bridgeport, CT 117 families Mean = 15.40 Mean = 18.40 Mean difference = -3.00 HomVEE calculated = 0.30 p > 0.05
ITSEA externalizing (proportion with clinically concerning problems)
FavorableUnfavorable or ambiguousNo Effect
12 months Bridgeport, CT 117 families % (adjusted) = 17.00 Adjusted mean % = 29.10 Difference = 12.10 HomVEE calculated = -0.42 p < 0.05
ITSEA externalizing (proportion with clinically concerning problems)
FavorableUnfavorable or ambiguousNo Effect
6 months Bridgeport, CT 117 families % (adjusted) = 22.80 Adjusted mean % = 36.50 Difference = -13.70 HomVEE calculated = -0.40 p > 0.05
ITSEA internalizing
FavorableUnfavorable or ambiguousNo Effect
12 months Bridgeport, CT 117 families Mean = 13.10 Mean = 14.60 Mean difference = -1.50 HomVEE calculated = 0.19 p > 0.05
ITSEA internalizing
FavorableUnfavorable or ambiguousNo Effect
6 months Bridgeport, CT 117 families Mean = 15.40 Mean = 15.80 Mean difference = -0.40 HomVEE calculated = 0.13 p > 0.05
ITSEA internalizing (proportion with clinically concerning problems)
FavorableUnfavorable or ambiguousNo Effect
12 months Bridgeport, CT 117 families % (adjusted) = 1.90 Adjusted mean % = 1.80 Difference = 0.10 HomVEE calculated = 0.03 p > 0.05
ITSEA internalizing (proportion with clinically concerning problems)
FavorableUnfavorable or ambiguousNo Effect
6 months Bridgeport, CT 117 families % (adjusted) = 3.50 Adjusted mean % = 1.60 Difference = 1.90 HomVEE calculated = 0.49 p > 0.05
Any ITSEA domain (proportion with clinically concerning problems)
FavorableUnfavorable or ambiguousNo Effect
12 months Bridgeport, CT 117 families % (adjusted) = 26.40 Adjusted mean % = 36.40 Difference = -10.00 HomVEE calculated = -0.28 p < 0.05

footnote124

Submitted by user on

HomVEE-calculated p-value is greater than 0.05, indicating that this result is not significant.

Any ITSEA domain (proportion with clinically concerning problems)
FavorableUnfavorable or ambiguousNo Effect
6 months Bridgeport, CT 117 families % (adjusted) = 26.30 Adjusted mean % = 44.40 Difference = -18.10 HomVEE calculated = -0.49 p > 0.05
Child language (proportion with clinically concerning problems)
FavorableUnfavorable or ambiguousNo Effect
12 months Bridgeport, CT 117 families % (adjusted) = 10.50 Adjusted mean % = 33.30 OR = 4.40 HomVEE calculated = -0.88 p < 0.05
Child language (proportion with clinically concerning problems)
FavorableUnfavorable or ambiguousNo Effect
6 months Bridgeport, CT 117 families % (adjusted) = 16.90 Adjusted mean % = 30.30 OR = 3.00 HomVEE calculated = -0.46 p < 0.05
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Linkages and referrals

Findings rated high

Child First
Show findings details
Outcome measure Effect Follow-up timing Sample Sample size Intervention group Comparison group Group difference Effect size Statistical significance
Percentage of desired services received that were received, child development
FavorableUnfavorable or ambiguousNo Effect
12 months Bridgeport, CT 117 families % = 99.00 % = 14.00 Difference = 85.00 HomVEE calculated = 3.89 p < 0.001
Percentage of desired services that were received
FavorableUnfavorable or ambiguousNo Effect
12 months Bridgeport, CT 117 families % = 91.20 % = 33.20 Difference = 58.00 HomVEE calculated = 3.93 p < 0.001
Percentage of desired services that were received
FavorableUnfavorable or ambiguousNo Effect
6 months Bridgeport, CT 117 families % = 88.10 % = 31.80 Difference = 56.30 HomVEE calculated = 3.79 p < 0.001
Percentage of desired services that were received—child mental health
FavorableUnfavorable or ambiguousNo Effect
12 months Bridgeport, CT 117 families % = 93.00 % = 2.00 Difference = 91.00 HomVEE calculated = 3.93 p < 0.001
Percentage of desired services that were received, early education
FavorableUnfavorable or ambiguousNo Effect
12 months Bridgeport, CT 117 families % = 88.00 % = 26.00 Difference = 62.00 HomVEE calculated = 1.84 p < 0.001
Percentage of desired services that were received, adult education
FavorableUnfavorable or ambiguousNo Effect
12 months Bridgeport, CT 117 families % = 62.00 % = 9.00 Difference = 53.00 HomVEE calculated = 1.70 p < 0.001
Percentage of desired services that were received, adult mental health
FavorableUnfavorable or ambiguousNo Effect
12 months Bridgeport, CT 117 families % = 92.00 % = 7.00 Difference = 85.00 HomVEE calculated = 3.05 p < 0.001
Percentage of desired services that were received, concrete needs
FavorableUnfavorable or ambiguousNo Effect
12 months Bridgeport, CT 117 families % = 89.00 % = 16.00 Difference = 73.00 HomVEE calculated = 2.27 p < 0.001
Percentage of desired services that were received, family support
FavorableUnfavorable or ambiguousNo Effect
12 months Bridgeport, CT 117 families % = 83.00 % = 9.00 Difference = 74.00 HomVEE calculated = 2.36 p < 0.001
Percentage of desired services that were received, medical services
FavorableUnfavorable or ambiguousNo Effect
12 months Bridgeport, CT 117 families % = 98.00 % = 78.00 Difference = 20.00 HomVEE calculated = 1.59 p < 0.001
Percentage of desired services that were received, social services
FavorableUnfavorable or ambiguousNo Effect
12 months Bridgeport, CT 117 families % = 93.00 % = 56.00 Difference = 37.00 HomVEE calculated = 1.42 p < 0.001
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In brief

Evidence of model effectiveness

Title General population Tribal population Domains with favorable effects
Child First Yes, Meets HHS Criteria Meets HHS criteria Does not meet HHS criteria for tribal population because the model has not been evaluated with a tribal population.
  • Child development and school readiness,
  • Linkages and referrals,
  • Maternal health,

Model description

Child First works to decrease the incidence of emotional and behavioral disturbance, developmental and learning problems, and abuse and neglect among high-risk young children and families. Child First serves pregnant women and families with children from birth through age 5. A mental health/developmental clinician and care coordinator work as a team to provide services that include a comprehensive assessment of child and family needs, observation and consultation in early care and education settings, a family and child plan of care, a parent-child mental health intervention, and care coordination. The model typically lasts 6 to 12 months, depending on a family’s needs. During the first month, the clinician and care coordinator conduct joint home visits twice per week, and thereafter visits occur either separately or jointly and at least weekly. 

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Extent of evidence

Results of search and review
Number of manuscripts
At least one finding was eligible for review…
1
  …and at least one finding rated high
1
  …and at least one finding rated moderate (but none rated high)
0
  …and all findings that were eligible for review rated low or indeterminate2
0
  …but manuscript is additional source3
0

For more information, see the research database. For more information on the criteria used to rate research, please see details of HomVEE’s methods and standards.

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Summary of findings

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Criteria established by the U.S. Department of Health and Human Services

Information based on comprehensive review of all high- and moderate-rated manuscripts
CriterionCriterion descriptionCriterion met?
1High- or moderate-quality impact study?Yes
2Across high- or moderate-quality studies, favorable impacts in at least two outcome domains within one sample OR the same domain for at least two non-overlapping samples?Yes
3Favorable impacts on full sample?Yes
4Any favorable impacts on outcome measures sustained at least 12 months after model enrollment?
Reported for all research but only required for RCTs.
Yes
5One or more favorable, statistically significant impact reported in a peer-reviewed journal?
Reported for all research but only required for RCTs.
Yes
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